Q: Can a hospital that is not a critical access hospital (CAH) bill professional charges on UB-04 claims, Type of Bill (TOB) 013X? I have not read anywhere that hospitals cannot bill this way, but usually when discussing revenue 96X and other professional revenue codes there is mention of CAHs only.
Q: When a patient presents with acute respiratory failure, as well as an overdose, is it ever appropriate to assign the acute respiratory failure as principal diagnosis, since it is an acute condition that would have occasioned the admission to the hospital?
Q: We operate a partial hospitalization program (PHP) and just heard from our billing office that there are new requirements for submitting claims. They want us to close out accounts weekly in order for them to bill them. We have done 30-day accounts prior to this and don’t see why they want to change things. Is there a certain timeframe required for billing these services? This is a huge inconvenience to make this work for the business office.
Q: A patient has multiple labs on the same date of service. We receive the following NCCI edit: “Code 80048 is a column two code of 80053. These codes cannot be billed together in any circumstances.” Should we only bill code 80053?
Q: I am never sure of correct sequencing when the admission is for flu, pneumonia, and asthma. Can you suggest proper sequencing, and if queries are needed?
Q: I have a patient with stage IV lung cancer that presented with fatigue, cough, and loss of appetite. Initially, they thought he had pulmonary nodular amyloidosis, but when they did an echocardiogram on day one they found a pericardial effusion. How would this be sequenced and coded?
Q: Are there any new HCPCS codes for recently released biosimilar products on the horizon? Our physicians and pharmacists are being contacted by the manufacturer about purchasing and using them, but we want to be sure we can report them appropriately.
Q: We are currently using a hybrid medical record, so we have standard query forms with multiple-choice options that cannot be modified at this time. We wanted to include a statement so our query doesn’t seem leading. Is our approach to the multiple-choice query format appropriate?
Q: Our providers are reluctant to document a correlation between symptoms and a true diagnosis. Do you have any good ways to get them to do this? For example, our providers document "diabetes" but they often don't include additional details that should be there (e.g., gestational diabetes or type II diabetes mellitus in pregnancy).
Q: We have a teenager with systemic lupus erythematosus and history of lupus nephritis who came into the ED with seizures. The physician admitted the patient with documentation of with status epilepticus and hypertensive urgency. The intensivists then documented hypertensive encephalopathy. What should we choose as the principal diagnosis?
Q: Can CPT® code 76700 (ultrasound, abdominal, real time with image documentation; complete) be coded with 76770 (ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited) on the same date of service during the same session?
Q: We are having trouble determining how to assign a code for a pressure ulcer that begins as a Stage I concern that is present on admission (POA) but advances during the patient’s stay to a Stage II or a Stage III. Coding Clinic, Fourth Quarter 2008, p. 194, tells us that even if the ulcer advances it would still be coded as POA, but would even an advanced stage still be considered POA?
Q: What is the proper ICD-10-CM coding for bilateral hip pain? Should we report M25.551 (pain in right hip) and M25.552 (pain in left hip) or M25.559 (pain in unspecified hip)?
Q: Can you clarify the expectations related to documenting the discussion between a physician and a clinical documentation improvement specialist when a query is done verbally? The 2013 ACDIS/AHIMA physician query practice brief Guidelines for Achieving a Compliant Query Practice expanded on the need to document this interaction and we’re wondering if our process is compliant.
Q: Our physicians sign off on diagnoses that the nursing staff prepares on admission of a new patient, can you suggest a process to capture all relevant diagnoses?
Q: When a foreign body is removed from the eye, does it matter what instrumentation is used to remove it? We recently had two cases in which the ED physician stated that the foreign body was easily removed with a cotton swab. She is questioning whether we should charge (facility and professional) for this type of removal or whether it should just be considered when determining the E/M level.
Q: In the past few weeks, we noticed physicians are documenting acute congestive heart failure with preserved ejection fraction instead of diastolic or systolic. They say the heart failure is not diastolic or systolic. What is the best way to approach this issue?
